title: Psychotic versus non-psychotic major depressive disorder: a comparative naturalistic study.
abstract: OBJECTIVE
  Psychotic depressed patients were found to have more severe cognitive deficits, poorer treatment response and higher suicidal risk respect to non-psychotic depressives. Aim of the present research was to compare clinical variables and outcome between psychotic and non-psychotic major depressive patients.
  
  
  METHODS
  A sample of 36 major depressed patients was divided into two groups according to the presence of psychotic symptoms. Structured Clinical Interview for DSM (SCID-I) and Hamilton Depression Rating Scale (HAM-D) were administered to the patients at baseline by trained raters. One-way analysis of variance (ANOVAs) and chi-square tests were performed to compare the two groups. Binary logistic regression was performed to assess the risk of lack of response/remission in patients with psychotic symptoms and the risk of developing psychotic symptoms in major depressives with a family history of schizophrenia or bipolar disorder.
  
  
  RESULTS
  Psychotic major depressives presented more severe illness as showed by HAM-D baseline scores (F=17.20, p<0.001), a longer duration of hospitalization (F=7.64, p=0.009) and they were more frequently treated with clomipramine (χ(2)=16.22, p=0.027). Psychotic symptoms were predictive of lack of remission (OR=4.09, p=0.05) and family history of schizophrenia/psychotic bipolar disorder was associated with psychotic major depression (OR=10.81, p=0.04).
  
  
  CONCLUSIONS
  Patients with psychotic symptoms present a more severe course of illness as showed by long hospitalizations and lower rates of remission. Psychotic depressives show more frequently a family history of "major psychoses" suggesting a continuum in psychotic disorders and a genetic association of major psychotic depression with bipolar disorder and schizophrenia.
authors.affiliation: Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Italy. massimiliano.buoli@hotmail.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Buoli
authors.forename: Alice
authors.initials: A
authors.lastname: Caldiroli
authors.forename: Alfredo Carlo
authors.initials: AC
authors.lastname: Altamura
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D012720:Severity of Illness Index